Case Manager Extender- TGH Care Coordination

A Brief Overview

The Case Management Extender (CME) is a patient-facing care coordination role that provides advanced operational, regulatory, and post-acute coordination support to the Case Management department. The primary function of this CME group is to decrease avoidable bed days and length of stay while ensuring safe, effective transitions of care across the continuum and beyond discharge.This role operationalizes Case Manager-identified discharge plans by coordinating post-acute services, appointments, transportation, and payer-aligned resources, allowing Case Managers to remain focused on bedside clinical assessment and planning. The CME ensures regulatory notice delivery in compliance with the Centers for Medicare & Medicaid Services (CMS) Conditions of Participation (CoPs) and serves as a subject matter expert in payer resources and post-acute network navigation to support successful community-based care plans

What you will do

• Deliver, document, and track MOON/HOON and other regulatory notices in a manner that ensures ongoing compliance with CMS CoP and AHCA and applicable regulatory standards
• Provide real-time communication and follow-up with Case Managers, Social Work, patients, families, and interdisciplinary teams
• Document all interventions clearly and timely in Epic and related systems
• Identify, secure, and coordinate cost-effective, in-network post-acute providers and services (e.g., home health, DME, SNF, LTACH, specialty services) based on Case Manager assessments
• Work directly with outside vendors, facilities, and community providers to obtain service acceptance and confirm readiness for discharge
• Verify payer network status, benefit coverage, and post-acute authorization progress to support timely transitions of care
• Ensure post-acute plans align with payer requirements, clinical needs, and safe discharge criteria
• Support patients and families by communicating appointment details, service expectations, and next steps as delegated
• Schedule post-discharge and post-acute appointments (specialty care, follow-up visits, procedures, services) as delegated
• Coordinate scheduling logistics to align with discharge readiness and post-acute service availability
• Document appointments, confirmations, and barriers in the medical record or designated tracking tools
• Obtain and coordinate multi-level transportation arrangements, including basic, ALS, critical care, bariatric, and ground or air transport as required
• Request and compare transportation quotes to support cost-effective, payer-aligned discharge planning
• Coordinate payer-authorized transportation and communicate logistics to patients, families, and care teams
• Maintain stewardship of TGH SWAT budget with respect to through review of pt CM/SW assessments, demographic input, and knowledge of available vendors and timeliness of start of service.
• Review for pending authorizations for post acute services and manage timeliness of process for efficient transition rom acute care setting by working with community partners and vendors.
• Escalates discharge barriers, payer constraints, network limitations, and compliance risks including potential CMS CoP and/or AHCA impacts to leadership
• Filing of reports in the event of insufficient care according to CMS and/or AHCA as directed by leadership.

Education Qualifications

• High School Diploma or GED

Experience Qualifications

• Experience in a hospital, clinical office, or insurance environment, with demonstrated knowledge of community-based resources and payer systems to support safe and effective patient outcomes.
• Proficiency in medical terminology is required.
• Candidates must demonstrate computer literacy, including experience with internet-based applications, Microsoft Office, and clinical electronic medical record (EMR) systems.

Skills and Abilities

• Strong multitasking, prioritization, and attention to detail
• Strong analytical and communication skills with the ability to read, interpret, and convey complex information effectively.
• Expertise in post-acute care coordination, payer networks, and community-based resources
• Demonstrated knowledge of CMS Conditions of Participation (CoP) related to regulatory notice delivery
• Demonstrated knowledge of Florida Agency for Health Care Administration (AHCA) related to regulatory notice delivery and guidelines.
• Professional communication with patients, families, vendors, and interdisciplinary teams
• Operationalize Case Manager-identified discharge plans by coordinating post-acute services, appointments, and resources needed to achieve timely, safe discharge
• Actively support reduction of length of stay and avoidable bed days by mitigating non-clinical discharge barriers, enabling Case Managers to remain at the bedside
• Epic (clinical documentation, CME requests, task lists) and all affiliated EMR tools utilized by TGH
• Payer portals, OnBase, RightFax, Availity, Accentra, Wellsky(as applicable to post-acute coordination)
• Microsoft Outlook, Teams, Excel for communication and tracking
• Departmental task boards and post-acute tracking tools
• Participates in department education, workflow improvement, and cross-training initiatives
• Commitment to Tampa General Hospital values and patient-centered care
• Ability to self-manage, prioritize multiple tasks, and adapt to changing priorities in a fast-paced environment.